A&E Attendances and Emergency Admissions

NHS England has released the latest A & E figures. The Weekly and Monthly A&E Attendances and Emergency Admissions collection collects the total number of attendances in the specified period for all A&E types, including Minor Injury Units and Walk-in Centres, and of these, the number discharged, admitted or transferred within four hours of arrival.

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Also included are the number of Emergency Admissions, and any waits of over four hours for admission following decision to admit.

The total number of attendances in January 2018 was 2,000,000, an increase of 5.5% on the same month last year. Of these, attendances at type 1 A&E departments were 1.6% higher. Attendances over the latest twelve months are 1.1 % higher than levels in the preceding twelve month period.
NHS England |A&E Attendances and Emergency Admissions |January 2018 Monthly figures data set from NHS England  A statistical commentary is available  from NHS EnglandRelated content:

The Guardian NHS hospitals in England record worst ever A&E performance

The Independent NHS A&E waiting times hit worst levels on record, show latest figures

 

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Alcohol identification and intervention in English emergency departments

Two UK researchers have conducted a national survey of English EDs to determine current practice regarding alcohol identification and provision of brief advice, and to compare changes in activity to a previous National Survey (conducted in 2011). 

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Aims
In the ED, alcohol identification and brief advice is an effective method of reducing consumption and related harms. Our objective was to conduct a national survey of English EDs to determine current practice regarding alcohol identification and provision of brief advice and to compare changes in activity to a previous National Survey conducted in 2011.

Methods
This was a cross-sectional survey of all consultant-led EDs in England.

Results
Of 180 departments, 147 (81.6%) responded. All departments may question adult patients about their alcohol consumption, with many (63.6%) asking all patients aged over 18 years as part routine care and using a formal screening tool (61.4%).

The majority of departments asked young people (aged 11–17 years) about their consumption (83.8%), but only 11.6% did so as a part of routine practice. Compared with the 2011 survey, there have been significant increases in routine screening among adults , general practitioners being informed about patients’alcohol-related presentations and access to an alcohol health worker or a clinical nurse specialist. Modest (non-significant) changes were also found in access to training on brief advice (9.7%) and the use of formal screening questions on adult patients (9.7%).

Conclusion Alcohol screening together with referral or intervention is becoming part of routine practice in England. Compared with our previous national survey, increases in alcohol screening and intervention activity are demonstrated, with improvements in routine questioning (among adults), the number of general practitioners being informed about alcohol-related attendances, provision of training, access to specialist services and the use of formal screening tools.

Full reference: Patton, R. & Green, G. | Alcohol identification and intervention in English emergency departments | Emerg Med J | 2018 | 35 |p. 75- 78 | doi http://dx.doi.org/10.1136/emermed-2016-206467

Full text article available from the EMJ here 

The emergency crisis was predictable- and partly preventable

The winter crisis experienced across the country was by no means inevitable say two consultant emergency physicians. They explain that in actuality this  winter phenomenon has been building steadily for years as a result of a toxic combination of increasing demand, full hospitals, and inadequate social care capacity which has created a perfect storm centred on under-resourced emergency departments.

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This situation was entirely predictable and partly preventable.  The current difficulties are because of inadequate acute bed  capacity and coordination in hospitals, which in turn is caused  by insufficient social care capacity. This has been made more difficult because of medical, nursing, and other staff shortages,
resulting from the abject failure in NHS workforce planning. There are particular problems in emergency medicine, acute medicine, and geriatric medicine. (BMJ)

The full piece is available for Athens users via the BMJ 

Full reference: Boyle, A. & Higginson, I.| The emergency crisis was predictable- and partly preventable|BMJ | 2018 |360|k64

 

 

Redesigning urgent and emergency care

The impact of redesigning urgent and emergency care in Northumberland | The Health Foundation

This report considers findings from analysis into the early impact of changes to urgent and emergency care services in Northumberland following the opening of the country’s first bespoke emergency hospital in 2015. It highlights that reconfiguring NHS services takes time to generate the intended results and that robust, repeat evaluation can help to inform decisions and improvement.

Full report: The impact of redesigning urgent and emergency care in Northumberland 

Waiting times in A&E departments

Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In recent years, patients have been waiting longer in A&E; this article from the Kings Fund explores the reasons behind this.

The article reports that not only are more people are attending A&E departments each year, but A&E waiting times have also increased substantially over recent years. The NHS has not met the standard at national level in any year since 2013/14, and the standard has been missed in every month since July 2015.

At the same time, longstanding staffing issues and continued reductions in the number of hospital beds have made it more difficult for A&E departments to admit patients.

Full article: What’s going on with A&E waiting times?

Urgent and emergency care: best practice

This CQC report offers practical examples of how leading emergency departments are meeting the challenges of managing capacity and demand, and managing risks to patient safety .

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This report from the Care Quality Commission details the good practice identified following the Commission’s work with consultants, clinical leads, senior nursing staff and managers from leading emergency departments in 17 NHS acute trusts.

This resource identifies:

  • strategies staff use to meet the challenge of increased demand and manage risks to patient safety
  • positive actions to address potential safety risks and to manage increased demand better
  • how working with others can manage patient flow and ensure patients get the care they need
  • that rising demand pressures in emergency departments are an issue for the whole hospital and local health economy.

Full report: Sharing best practice from clinical leaders in emergency departments

Addressing ambulance handover delays

NHS England has written to ambulance trusts setting out actions that need to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

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 ‘Addressing ambulance handover delays: Actions for Local A&E Delivery Boards’ sets out the main points from recent guidance documents, and separates them into actions to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

There are 4 key principles:

  • The patients in the urgent care pathway who are at highest risk of preventable harm are those for whom a high priority 999 emergency call has been received, but no ambulance resource is available for dispatch.
  • Acute Trusts must always accept handover of patients within 15 minutes of an ambulance arriving at the ED or other urgent admission facility (e.g. medical/surgical assessment units, ambulatory care etc.)
  • Leaving patients waiting in ambulances or in a corridor supervised by ambulance personnel is inappropriate.
  • The patient is the responsibility of the ED from the moment that the ambulance arrives outside the ED department, regardless of the exact location of the patient.

Full document:  ‘Addressing ambulance handover delays: Actions for Local A&E Delivery Boards’